Provider Demographics
NPI:1457095739
Name:WHEELER-DUBIN, KATIE E (LAC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:E
Last Name:WHEELER-DUBIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:WHEELER-DUBIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:240-B CARL STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117
Mailing Address - Country:US
Mailing Address - Phone:415-299-2384
Mailing Address - Fax:
Practice Address - Street 1:40 HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1362
Practice Address - Country:US
Practice Address - Phone:415-299-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19432171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist